Complications of Myocardial Infarction

Mnemonic: DARTH VADER



Death



Arrhythmia



* ACS patients need to be placed on cardiac monitor* Frequently degenerate into non-perfusing rhythms



Rupture of Ventricle



* Occur within a few days of myocardial infarction* Rapid decompensation* Bedside ultrasound will show pericardial effusion and tamponade



Tamponade



* Multiple etiologies* Rupture of ventricle (see above)* Pericarditis* Becks Triad* Jugular vein distension* Muffled heart sounds* Hypotension* Diagnosed with bedside ultrasound* Treatment is pericardiocentesis



Heart Failure



* Occurs in approximately 1/3 post-MI patients* Leads to cardiogenic shock* Treatment* Fluid bolus* Vasopressors (esp. norepinephrine)* Inotropes (milrinone, dobutimine)* Left ventricular assist devices* Intra-aortic balloon pumps



Valve Failure/Rupture



* Rapid decompensation (similar to ventricular wall rupture)* PLUS* New heart murmur* Surgical emergency



Aneurysm



* A classic STEMI mimic* Large Q waves with ST segment elevation (IN ASYMPTOMATIC PATIENT)



Dresslers Syndrome/Pericarditis



* Rule out cardiac tamponade* Treatment* NSAIDS/colchicine



Embolism



* Occur in damaged ventricles and in cardiac aneurysms* Require anticoagulation



Recurrence



* Emphasize lifestyle management



Additional Reading



* Approach to STEMI (EM Clerkship)